Epemolu O, Bom A, Hope F, Mason R. Reversal of neuromuscular blockade and simultaneous increase in plasma rocuronium concentration after the intravenous infusion of the novel reversal agent Org 25969. Anesth. 2003;99:632-637.
Bridion® [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp, 2015.3.
Bloxiverz® [package insert]. Chesterfield, MO: Eclat Pharmaceuticals: 2015.
Khuenl-Brady KS, Wattwil M, Vanacker BF, et al. Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: a multicenter, randomized, controlled trial Anesth Analg. 2010;110:64-73.
Gaszynski T, Szewczyk T, Gaszynski W. Randomized comparison of sugammadex and neostigmine for reversal of rocuronium-induced muscle relaxation in morbidly obese undergoing general anaesthesia. Br J Anaesth. 2012;108:236-239. Abstract
Brueckmann B, Sasaki N, Grobara P, et al. Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study. Br J Anaesth. 2015;115:743-751. Abstract
Sasaki N, Meyer MJ, Malviya SA, et al. Effects of neostigmine reversal of nondepolarizing neuromuscular blocking agents on postoperative respiratory outcomes: a prospective study. Anesthesiology. 2014;121:959-968. Abstract
Haerter F, Eikermann M. Reversing neuromuscular blockade: inhibitors of the acetylcholinesterase versus the encapsulating agents sugammadex and calabadion. Expert Opin Pharmacother. 2016;17:819-833. Abstract
Butterly A, Bittner EA, Sandberg WS, et al. Postoperative residual curarization from intermediate-acting neuromuscular blocking agents delays recovery room discharge. Br J Anaesth. 2010;105:304-309. Abstract
Yip PC, Hannam JA, Cameron JD, et al. Incidence of residual neuromuscular blockade in a post-anaesthetic care unit. Anaesth Intensive Care. 2010;38:91-95. Abstract
Kopman AF, Zank LM, Ng J, Neuman GG. Antagonism of cisatracurium and Rocuronium block at a tactile train-of-four count of 2: should quantitative assessment of neuromuscular function be mandatory? Anesth Analg. 2004;98:102-106. Abstract
Suzuki T, Masaki G, Ogawa S. Neostigmine-induced reversal of vecuronium in normal weight, overweight and obese female patients. Br J Anaesth. 2006;97:160-163 Abstract
Brull SJ, Murphy GS. Residual neuromuscular block: lessons unlearned. Part II: methods to reduce the risk of residual weakness. Anesth Analg. 2010;111:129-140. Abstract
Blobner M, Eriksson LI, Scholz J, et al. Reversal of rocuronium-induced neuromuscular blockade with sugammadex compared with neostigmine during sevoflurane anaesthesia: results of a randomised, controlled trial. Eur J Anaesth. 2010;110:64-73.
Naguib M, Brewer L, LaPierre C, Kopman AF, Johnson KB. The myth of rescue reversal in "Can't Intubate, Can't Ventilate" scenarios. Anesth Analg. 2016;123:82-92. Abstract
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Naguib M, Kopman AF, Lien CA, et al. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010;111:110-119. Abstract
Viby-Mogensen J, Jensen NH, Engbaek J, et al. Tactile and visual evaluation of the response to train-of-four nerve stimulation. Anesthesiology. 1985;63:440-443. Abstract
Brull SJ, Silverman DG. Visual and tactile assessment of neuromuscular fade. Anesth Analg 1993;77:352-355.
Osmer C, Vogele C, Zickmann B, Hempelmann G. Comparative use of muscle relaxants and their reversal in three European countries: a survey in France, Germany and Great Britain. Eur J Anaesthesiol 1996;13:389-399.
Fuchs-Buder T, Hofmockel R, Geldner G, et al. The use of neuromuscular monitoring in Germany. Anaesthesist. 2003;52:522-–526. Abstract
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Caldwell JE. Reversal of residual neuromuscular block with neostigmine at one to four hours after a single intubating dose of vecuronium. Anesth Analg. 1995;80:1168–1174.
Kopman AF, Eikermann M. Antagonism of non-depolarizing neuromuscular block: current practice. Anaesthesia. 2009;64:22-30. Abstract
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Moderator(s)

Cynthia Lien, MD

Professor of Anesthesiology; Vice Chair for Academic Affairs, Weill Cornell Medical Center, New York, New York

Disclosures

Disclosure: Cynthia Lien, MD, has disclosed the following relevant financial relationships:
Received grants for clinical research from: Merck & Co., Inc.

Dr Cynthia Lien does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Cynthia Lien does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Presenter(s)

Richard C. Prielipp, MD, MBA

Professor of Anesthesiology, University of Minnesota, Minneapolis, Minnesota

Disclosures

Disclosure: Richard C. Prielipp, MD, MBA, has disclosed the following relevant financial relationships:
Served as a speaker or a member of a speakers bureau for: Merck & Co., Inc.

Dr Prielipp does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Prielipp does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Mark Welliver, DNP, CRNA, ARNP

Associate Professor of Professional Practice, School of Nurse Anesthesia, Harris College of Nursing & Health Sciences, Texas Christian University, Fort Worth, Texas

Disclosures

Disclosure: Mark Welliver, DNP, CRNA, ARNP, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Merck & Co., Inc.
Served as a speaker or a member of a speakers bureau for: Merck & Co., Inc.

Dr Mark Welliver does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Mark Welliver does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editor(s)

Stacey J.P. Ullman, MHS

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Stacey J.P. Ullman, MHS, has disclosed no relevant financial relationships.

CME Reviewer/Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Lead Nurse Planner, Medscape, LLC

Disclosures

Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.

CME / CE

New Approaches to the Safe and Effective Reversal of Neuromuscular Blockade

Authors: Cynthia Ann Lien, MD; Richard C. Prielipp, MD, MBA; Mark Welliver, DNP, CRNA, ARNP
CME / CE Released: 9/20/2016
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 9/20/2017, 11:59 PM EST

Start Activity

Target Audience and Goal Statement

This activity is intended for anesthesiologists, surgeons, neurologists and nurses.

The goal of this activity is to understand how newly approved sugammadex compares with other current neuromuscular blockade (NMB) reversal agents and to encourage greater use of quantitative monitoring to improve patient safety.

Upon completion of this activity, participants will have increased knowledge regarding the:

Mechanism of action of available NMB reversal agents
Differential clinical effects of available NMB reversal agents
Risks and benefits of available NMB blockade reversal agents

Disclosures

Moderator(s)

Cynthia Lien, MD

Professor of Anesthesiology; Vice Chair for Academic Affairs, Weill Cornell Medical Center, New York, New York

Disclosures

Disclosure: Cynthia Lien, MD, has disclosed the following relevant financial relationships:
Received grants for clinical research from: Merck & Co., Inc.

Dr Cynthia Lien does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Cynthia Lien does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Presenter(s)

Richard C. Prielipp, MD, MBA

Professor of Anesthesiology, University of Minnesota, Minneapolis, Minnesota

Disclosures

Disclosure: Richard C. Prielipp, MD, MBA, has disclosed the following relevant financial relationships:
Served as a speaker or a member of a speakers bureau for: Merck & Co., Inc.

Dr Prielipp does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Prielipp does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Mark Welliver, DNP, CRNA, ARNP

Associate Professor of Professional Practice, School of Nurse Anesthesia, Harris College of Nursing & Health Sciences, Texas Christian University, Fort Worth, Texas

Disclosures

Disclosure: Mark Welliver, DNP, CRNA, ARNP, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Merck & Co., Inc.
Served as a speaker or a member of a speakers bureau for: Merck & Co., Inc.

Dr Mark Welliver does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Mark Welliver does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editor(s)

Stacey J.P. Ullman, MHS

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Stacey J.P. Ullman, MHS, has disclosed no relevant financial relationships.

CME Reviewer/Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Lead Nurse Planner, Medscape, LLC

Disclosures

Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.

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From Medscape Education Anesthesiology

CME / CE

New Approaches to the Safe and Effective Reversal of Neuromuscular Blockade

Authors: Cynthia Ann Lien, MD; Richard C. Prielipp, MD, MBA; Mark Welliver, DNP, CRNA, ARNPFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / CE Released: 9/20/2016

Valid for credit through: 9/20/2017, 11:59 PM EST

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The educational activity presented above may involve simulated case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient is intended or should be inferred.

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

References

Faculty and Disclosures

Moderator(s)

Cynthia Lien, MD

Presenter(s)

Richard C. Prielipp, MD, MBA

Mark Welliver, DNP, CRNA, ARNP

Editor(s)

Stacey J.P. Ullman, MHS

CME Reviewer/Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Peer Reviewer

CME / CE

New Approaches to the Safe and Effective Reversal of Neuromuscular Blockade

Target Audience and Goal Statement

Disclosures

Moderator(s)

Cynthia Lien, MD

Presenter(s)

Richard C. Prielipp, MD, MBA

Mark Welliver, DNP, CRNA, ARNP

Editor(s)

Stacey J.P. Ullman, MHS

CME Reviewer/Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Peer Reviewer

Accreditation Statements

For Physicians

For Nurses

Instructions for Participation and Credit

New Approaches to the Safe and Effective Reversal of Neuromuscular Blockade